Massachusetts EVV requirements and claim edits

Three phases, the last one scheduled

MassHealth staged EVV in three steps: register, hit a rising share of clean visits, then let the billing system refuse claims with no matching visit. The first two have dates. The third is scheduled for September 2026, and no document read here says it began.

Status as of October 11, 2026, the day these copies were downloaded and read.

Two dates bear on hard edits. The three provider bulletins set a floor: MassHealth would add the edits no earlier than July 2026. The Hard Edits Cheat Sheet then schedules the hard-edit go-live for September 2026. None of the eight documents reports that the go-live happened, and the edits guide, in the copy read on October 11, 2026, still tells agencies to prepare for when hard edits arrive.

MassHealth in its own words

• On phase 3, Home Health Agency Bulletin 94 in the copy read October 11, 2026: “No earlier than July 2026, MassHealth will implement edits into its billing system to allow claims to pay only when a corresponding visit is correctly entered into the EVV system.”
• On what counts toward a checkpoint, the same bulletin: auto-approved visits are “visits submitted in the EVV system that have not been corrected manually by the provider.”
• On the hard edits, the edits guide read October 11, 2026: they “will result in claims denial if the submitted claims do not have matching EVV visit records.”
• On the model, the May 2024 overview deck: providers “can use their own EVV System and send their EVV-related data to the EVV Data Aggregator, or they can utilize the EVV System that the State will provide.”

Sandata on both sides

In Massachusetts one company does two jobs. Sandata Technologies supplies the state’s own EVV system for agency-based services and also runs the aggregator that receives visits from the state system and from registered alternate systems. An agency that prefers its own software registers it as an alternate EVV system; its visits still go to the Sandata aggregator, carrying the same six data elements. The May 2024 overview deck names a different vendor, Tempus Unlimited, for self-directed personal care attendant EVV.

GPS in the MassHealth papers

The six data elements include where the service was delivered. Beyond that, none of the eight documents makes GPS a condition. The one mention is in the May 2024 overview deck, which lists, among the features of Sandata’s phone app, that it records GPS when a visit starts and ends. That is a property of one app, not a line in a bulletin.

Visits fixed by hand

Massachusetts measures agencies on visits nobody had to touch. A visit captured at clock-in and clock-out counts as auto-verified; one that was keyed in or edited afterwards counts as manually verified. The checkpoints only credit the first kind, so an agency that repairs many visits can sit below the bar even when every visit is complete. For claims, the edits guide treats both kinds as able to match, provided the visit is in a verified status before the claim arrives.

What follows a missed checkpoint

The bulletins describe two steps: a notice of noncompliance on a first miss, then a formal notice of sanction on a second, with termination from the MassHealth provider network possible beyond that. They cite two MassHealth regulations, 130 CMR 450.238 and 450.239, which this page did not read and does not characterise. For health plans, Bulletin 137 points to corrective action or intermediate sanctions under each plan’s contract.

Known, and not yet known

Known from the documents: the September 2024 start, the registration windows, the three checkpoint levels and their periods, soft edits from October 2025, the July 2026 floor for hard edits and their September 2026 schedule, and the Sandata arrangement. The edits guide’s table already marks an unmatched EVV line “No Pay”, with a note that this may not reflect how the whole claim is decided; it says no more than that about payment under soft edits. Not known from the documents: whether the scheduled September 2026 go-live took place, whether the checkpoint levels have moved since May 30, 2025, dates for the health-plan phases, and how the cited regulations apply. Earlier search results on these points were never treated as facts here.

LockProof beside MassHealth EVV

The aggregator answers MassHealth’s question: is there a verified visit behind this claim. A LockProof photo answers a narrower one: what the caregiver’s camera recorded at the visit, held so that editing it afterwards would show. How the two sit side by side is covered in photo records kept next to an EVV system, and the capture itself gets its own walkthrough.

Scope of this page

Every source is a copy the founder downloaded from mass.gov on October 11, 2026. Six links go to the download addresses recorded for those copies; the links for Bulletin 137 and the overview deck go to MassHealth listing pages instead. Our network cannot open mass.gov, so no link was opened from here; if one has moved, the bulletin numbers will turn the bulletins up, and Bulletins 94 and 24 point readers to MassHealth’s “Electronic Visit Verification for Agency-based Providers” page for the checkpoint figures. The edits guide carries no date of its own. Agency contracts, waivers and plan terms were not reviewed; that is for counsel. Other states are on the state EVV overview, including Minnesota’s rewritten statute.